Content analysis to locate assistive technology in Queensland's motor injury insurance rehabilitation legislation and guidelines.

INTRODUCTION: Reforms to Australia's disability and rehabilitation sectors have espoused the potential of assistive technology as an enabler. As new insurance systems are being developed it is timely to examine the structure of existing systems. This exploratory study examined the policies guiding assistive technology provision in the motor accident insurance sector of one Australian state. METHODS: Policy documents were analyzed iteratively with a set of qualitative questions to understand the intent and interpretation of policies guiding assistive technology provision. Content analysis identified relevant sections and meaningful terminology, and context analysis explored the dominant perspectives informing policy. RESULTS AND DISCUSSION: The concepts and language of assistive technology are not part of the policy frameworks guiding rehabilitation practice in Queensland's motor accident insurance sector. The definition of rehabilitation in the legislation is consistent with contemporary international interpretations that focus on optimizing functioning in interaction with the environment. However, the supporting documents are focused on recovery from injuries where decisions are guided by clinical need and affordability. CONCLUSION: The policies frame rehabilitation in a medical model that separates assistive technology provision from the rehabilitation plan. The legislative framework provides opportunities to develop and improve assistive technology provision as part of an integrated approach to rehabilitation.

Perspectives of individuals receiving occupational therapy services through the National Disability Insurance Scheme: Implications for occupational therapy educators.

INTRODUCTION: With the introduction of the National Disability Insurance Scheme (NDIS) in Australia, occupational therapy graduates need to be adequately prepared to support service users in this new policy context. There is, however, limited research informed by service users themselves to inform contemporary occupational therapy curriculum redesign. The aims of this study were: (a) to explore the experience of occupational therapy service provision from the perspective of service users with lived experience of disability; (b) to gain an understanding of the perceptions of people with lived experience of disability regarding the NDIS and whether it will change how they work with occupational therapists; (c) to gain an understanding of the perspectives of people with lived experience of disability regarding the NDIS, and how this influences curriculum content for occupational therapy education. METHODS: A pragmatic qualitative design, underpinned by the constructivist paradigm was utilised. Demographic surveys and semi-structured interviews were completed with 10 participants who were purposively recruited. Peer debriefing and use of an audit trail were undertaken to enhance the rigour of the analysis. RESULTS: Three themes were identified: (a) Occupational therapists as gatekeepers for equipment provision; (b) experience of the NDIS (Knowledge and understanding of the NDIS; Uncertainty regarding the NDIS; Choice and control in the NDIS); (c) curriculum content for occupational therapy. CONCLUSION: The insights provided by the people with lived experience in this study inform key areas of focus for occupational therapy curriculum to adequately prepare graduates to work in the evolving NDIS environment. Involving service users in an authentic manner in curriculum design, content delivery and student assessment is crucial for "real-world" applicability of student education.

Culture clash? Recovery in mental health under Australia's National Disability Insurance Scheme - a case study.

OBJECTIVE: Using a case study, we aim to report on the compatibility of funding and policy settings under Australia's National Disability Insurance Scheme (NDIS) with the delivery of evidence based, recovery-oriented psychosocial services. Type of program or service: We reflect on the impact of the NDIS on a psychosocial rehabilitation service run by Woden Community Service (WCS), one of the major service providers in the Australian Capital Territory, and specifically its Transition to Recovery (TRec) program. METHODS: We examine NDIS funding and policy settings and consider the recovery-oriented practices underpinning psychosocial programs like TRec. The construct of the program, its staffing and related issues are considered. The article draws on a formal evaluation of TRec conducted in 2015. RESULTS: The NDIS is having a seismic impact on Australia's psychosocial sector. Despite its positive evaluation, the future of the TRec program is problematic. Practically, service exit points have disappeared, reducing the program's capacity to properly transition clients between services and effectively increasing the likelihood of relapse. More generally, current NDIS policies are threatening the fidelity of WCS's approach to recovery practice. LESSONS LEARNT: This case study highlights tension between a new public insurance scheme primarily aimed at better managing consistent conditions and circumstances, and the recovery philosophy which has emerged in relation to episodic mental illness. This has implications for psychosocial services nationwide. The psychosocial rehabilitation sector has always been a peripheral element of Australia's mental health service mix. The advent of the NDIS offers hope that this may change. However, WCS's experience suggests that the NDIS must reconsider how best to foster recovery-oriented practice in mental health. This should be part of a more fundamental reconceptualisation of the role of psychosocial rehabilitation services in contemporary mental health care, not just for NDIS recipients. This work is urgent if Australia is to nurture its already rare psychosocial rehabilitation workforce and not see it dissipate.

Organisational impact of the National Disability Insurance Scheme transition on mental health care providers: the experience in the Australian Capital Territory.

OBJECTIVES:: Concerns raised about the appropriateness of the National Disability Insurance Scheme (NDIS) in Australia for people with mental illness have not been given full weight due to a perceived lack of available evidence. In the Australian Capital Territory (ACT), one of the pilot sites of the Scheme, mental health care providers across all relevant sectors who were interviewed for a local Atlas of Mental Health Care described the impact of the scheme on their service provision. METHODS:: All mental health care providers from every sector in the ACT were contacted. The participation rate was 92%. We used the Description and Evaluation of Services and Directories for Long Term Care to assess all service provision at the local level. RESULTS:: Around one-third of services interviewed lacked funding stability for longer than 12 months. Nine of the 12 services who commented on the impact of the NDIS expressed deep concern over problems in planning and other issues. CONCLUSIONS:: The transition to NDIS has had a major impact on ACT service providers. The ACT was a best-case scenario as it was one of the NDIS pilot sites.

Activation against absenteeism - Evidence from a sickness insurance reform in Norway.

I evaluate a program aimed at strictly enforcing a requirement that people on long-term sick leave be partly back at work unless explicitly defined as an exception. Employing the synthetic control method, I find that the reform reduced work-hours lost due to sickness absenteeism by 12% in the reform region compared to a comparison unit created by a weighted average of similar regions. The effect is driven by both increased part-time presence of temporary disabled workers and accelerated recovery. Musculoskeletal disorders was the diagnosis group declining the most. The findings imply large savings in social security expenditures.

How disability insurance reforms change the consequences of health shocks on income and employment.

This paper examines whether Dutch disability insurance reforms have helped or hindered employment opportunities of workers that are facing unanticipated shocks to their health. An important component of the reforms was to make employers responsible for paying sickness benefits and to strengthen their sickness monitoring obligations. This may stimulate preventive and reintegration activities by firms. Using administrative data on hospitalizations, we conclude that both financial incentives and monitoring obligations have substantially lowered DI receipt and increased the employment of workers after a health shock.

Does experience rating reduce sickness and disability claims? Evidence from policy kinks.

We study whether the experience rating of employers' disability insurance premiums affects the inflow to disability benefits in Finland. To identify the causal effect of experience rating, we exploit kinks in the rule that specifies the degree of experience rating as a function of firm size. Using comprehensive matched employer-employee panel data, we estimate the effects of experience rating on the inflow to sickness and disability benefits. We find that experience rating has little or no effect on either of these outcomes.

Social Security and Disability Due to Mental Impairment in Adults.

The Social Security Administration (SSA) oversees two disability programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Adults with mental impairments represent a very large component of the programs. Policy makers and SSA are concerned about the accuracy of disability determination and also about low levels of labor force participation among individuals with disabilities. Adults with mental impairments are challenging to assess for work-related functional limitations. They are also a challenge to return to labor force participation. SSA has sponsored several demonstration research programs focusing on improving the accuracy of disability determination and on interventions in supported employment to return individuals with mental impairments to competitive employment. This article reviews the demonstration research focused on both entry into the disability system (at the "front door") and potential exit from it (through the "back door"). All of the research holds promise to "right-size" the SSA disability program.

Ensuring Program Uniformity at the Hearing and Appeals Council Levels of the Administrative Review Process. Final rule.

We are revising our rules so that more of our procedures at the hearing and Appeals Council levels of our administrative review process are consistent nationwide. We anticipate that these nationally consistent procedures will enable us to administer our disability programs more efficiently and better serve the public.

[Follow-up Care in the Field of Medical Rehabilitation Concerning Psychosomatic Indications Based on the New Conceptual Framework of the German Pension Insurance]. / Nachsorge im Bereich der psychosomatischen Rehabilitation nach dem neuen Rahmenkonzept der Deutschen Rentenversicherung.

Mental disorders rank first amongst all causes for disability pensions and second in the field of medical rehabilitation. Especially alarming is the significantly lower age of entry of the mentally ill disability pensioners, compared to those with other indications. Mentally ill people often look back at a long history of diseases before getting in contact with the German pension insurance. In this regard the German pension insurance, which is obligated to effectively support people in order to keep them in working life until reaching the regular retirement age, is facing a big challenge, which stands right next to further demands, due to the demographic change, the increase of chronic diseases, multimorbidity, retirement age of 67 and changes in the working environment.With their activities in the field of medical rehabilitation the German pension insurance is aiming at the reintegration of people whose working capacity is endangered or reduced into the labor force or to prevent them from leaving it early. One of the main challenges notably in the field of mental diseases is to keep the success of the medical rehabilitation long-lasting. In this regard the post-rehabilitation provisions of the German pension insurances offer support according to §â€Š31 I 1 Nr. 1 Social Insurance Code VI, if so required.On January 1st, 2016 the German pension insurance has adopted a new conceptual framework in the field of post rehabilitation which is presented in the following article, covering the range of psychosomatic indications. The aim of the new conceptual framework, which has to be implemented within the next three years, is to establish a nationwide, uniformed and preferably comprehensive follow-up care concept, which can be referred to by everyone, regardless which agency of the German pension insurance is in charge.

Problemas derivados de la indeterminación legal de la profesión habitual. Situaciones de compatibilidad no deseadas y propuestas de revisión / Problems arising from the legal profession habitual indeterminacy. Compatibility unwanted situations and proposed revisions

La determinación de la profesión habitual se configura como una de las piezas clave del sistema por el que se rige la declaración de invalidez permanente. Lo es porque determina tanto la procedencia de la declaración inicial de la invalidez, de manera fundamental en la incapacidad permanente total, como la compatibilidad de la misma una vez reconocida con el trabajo, con un salario o con una posible prestación futura derivada del mismo. La indeterminación legal de los parámetros que configuran el reconocimiento de una situación de invalidez deriva, en situaciones de compatibilidad difíciles de justificar. Sin duda la más sorprendente es la prácticamente absoluta compatibilidad de la situación de incapacidad permanente absoluta y de gran invalidez con el trabajo, según la doctrina configurada por el Tribunal Supremo. También hay dificultad para revisar el grado de incapacidad reconocido, puesto que la misma ha de ajustarse a los motivos tasados por el legislador. CONCLUSIONES: - Delimitar el concepto de profesión habitual de una forma de manera que se amplíe desde el marco reducido de las funciones al más amplio del grupo profesional o, cuando menos, al que habilita al empresario para efectuar la movilidad funcional. - Modificar las actuales causas de revisión de la invalidez posibilitando que la mejoría también pueda ser considerada desde la perspectiva profesional, bien por la adaptación y rehabilitación funcional posterior o bien porque las modificaciones de los procesos productivos modifiquen la capacidad profesional inicialmente determinada. - Determinar en supuestos de nuevo trabajo si es compatible con las limitaciones funcionales objetivadas e impedir así el desempeño de trabajos con requerimientos similares o superiores a los que provocaron el reconocimiento de la situación de IPT. - Suspender la pensión de IPT en el supuesto de que el beneficiario de la misma simultaneé su percibo con el desempeño de la misma profesión, o funciones, o de otras que exijan los mismos requerimientos que aquella para la que fue declarado inválido. - Vincular la declaración de IPT a planes de formación para la búsqueda de empleo y rehabilitación ocupacional, asociando el percibo de la prestación por IPT a la búsqueda activa de empleo mediante la obligatoriedad de participar en programas de formación destinados a facilitar la reincorporación a la vida laboral activa. - Valoración de la incidencia de la edad y la formación en el reconocimiento de las situaciones de incapacidad permanente. - Profundizar en el análisis del paralelismo o correlación entre las prestaciones de desempleo y de IPT

Determining the usual profession it is configured as one of the key parts of the system by which the declaration of permanent disability is governed. It is because it determines both the origin of the initial declaration of invalidity, fundamentally in the total permanent disability, such as support of it once awarded the job, with a salary or a possible future benefit arising therefrom. The legal uncertainty of the parameters that make up the recognition of a situation of invalidity stems in difficult situations justify compatibility. Undoubtedly the most striking is the almost complete compatibility of the situation of absolute permanent disability and severe disability to work, according to the doctrine set by the Supreme Court. There is also difficulty revising the recognized degree of disability, since it must comply with the reasons assessed by the legislature. CONCLUSIONS: - Define the concept of habitual profession in a way so that it extends from the small part of the broader functions of the professional group or at least, which enables the employer to make functional mobility. - Modify the current review of the causes of disability enabling the improvement also can be considered from the professional perspective, either by post or adaptation and functional rehabilitation because changes in production processes initially determined modify the professional capacity. - Determine in cases of new job if it is compatible with the objectified functional limitations and thus prevent the performance of similar or higher work requirements that led to the recognition of the status of IPT. - Suspend IPT pension in the event that the beneficiary of the juggled her perceive with the performance of the same profession, or functions, or other requiring the same requirements as that for which was declared invalid. - Linking statement IPT training plans for job search and occupational rehabilitation, associating collect the benefit for IPT to active job search by mandatory to participate in training programs to facilitate the return to life active labor. - Assessment of the impact of age and training in recognizing situations of permanent disability. - Deepen the parallelism analysis or correlation between unemployment benefits and IPT

Problems, policies and politics: making the case for better assistive technology provision in Australia.

PURPOSE: Substantial evidence supports assistive technology and environmental adaptations as key enablers to participation. In order to realise the potential of these interventions, they need to be both recognised in policy, and resourced in practice. This paper uses political theory to understand the complexities of assistive technology (AT) policy reform in Australia. AT research will not be influential in improving AT policy without consideration of political drivers. METHOD: Theories of policy formation are considered, with Kingdon's (2003) theory of multiple streams identified as a useful lens through which to understand government actions. This theory is applied to the case of current AT policy reformulation in Australia. RESULTS: The convergence model of problem identification, policy formulation and political will is found to be an applicable construct with which to evaluate contemporary policy changes. This paper illustrates the cogency of this theory for the field of AT, in the case of Australia's recent disability and aged care reforms. CONCLUSIONS: Political theory provides a way of conceptualising the difficulties of consumers and AT practitioners experience in getting therapeutically valid solutions into public policy, and then getting policies prioritised and funded. It is suggested that AT practitioners must comprehend and consider political factors in working towards effective policies to support their practice. IMPLICATIONS FOR REHABILITATION: AT practitioners generally lack political awareness or an understanding of the drivers of policy. The effectiveness of AT practitioners at a systemic level will remain limited without consideration of policy drivers. AT practitioners must comprehend and consider political factors in working towards effective policies to support their practice.

Informing the Australian government on AT policies: ARATA's experiences.

UNLABELLED: This article describes the development and dissemination of an evidence-based Policy Statement and Background Papers by the Australian Rehabilitation and Assistive Technology Association (ARATA). An experienced project team was engaged to conduct literature reviews and member consultations, develop resources and implement a targeted advocacy strategy that included a policy launch and meetings with government officials. The Policy Statement and Background Papers have enabled ARATA to represent the views of Assistive Technology (AT) Practitioners in consultations around the National Disability Insurance Scheme and other AT-related inquiries. In ARATA's experience, developing a policy statement and disseminating it through a targeted advocacy strategy is an effective way for a not-for-profit professional organisation to influence government policy. IMPLICATIONS FOR REHABILITATION: AT practitioners must consider political factors in working towards effective policies to support their practice. To be effective at a systemic level, AT practitioners must develop political awareness and an understanding of the drivers of policy. This case study provides a blueprint for AT practitioners and organisations in tackling policy change.

La valoración de la profesión, del trabajo, de la ocupación, y de las tareas en el procedimiento de valoración de la capacidad laboral en materia de seguridad social / Labour abilities evaluation process in the spanish social security: profession, job occupation and taks evaluation

La valoración profesional es pieza capital en la valoración de la capacidad laboral en el trabajo en las inspecciones médicas del Instituto Nacional de la Seguridad Social, ya que nuestro sistema de valoración de la capacidad/incapacidad laboral es esencialmente laboral o profesional, precisando valorar las limitaciones funcionales u orgánicas en relación de su carácter incapacitante respecto de las funciones que su trabajo o el trabajo en general. En este artículo se exponen los aspectos básicos en la valoración profesional o laboral, repasando los conceptos de Profesión, Capacidad Laboral, Requerimientos laborales, Aptitud, Capacitado, Incapacitado, así como el procedimiento en Valoración de la Capacidad Laboral, y una reseña al criterio de calificación profesional y al específico de la profesión habitual. Si bien es urgente la definición, en nuestro sistema de seguridad social establecer una actualización y definición de las aptitudes a valorar, y del concepto de profesión, ocupación, trabajo y tareas. Así como implantar una metodología de valoración debidamente contrastada y normalizada, tanto con su referencia normativa que proceda, como por su uso extensivo, como por su contraste científico validado. Conclusiones: Para una correcta valoración de la capacidad laboral, urge una metodología de valoración debidamente contrastada y normalizada, tanto por su referencia a publicación normada, como por su uso extensivo, como por su contraste científico validado. La valoración de las aptitudes o capacidades laborales requeridas por el trabajo necesita establecer un sistema común y una actualización y definición de las aptitudes a valorar, y del concepto de profesión, ocupación, trabajo y tareas. Es por tanto esencial precisar qué valoramos y cómo lo hacemos, en la valoración "profesional" o de la "capacidad laboral" u "ocupacional" o del "trabajo" en nuestro actual marco del sistema de seguridad social, y propugnar a la par una actualización de conceptos de la incapacidad y una reforma legal de la normativa que facilite la adecuación de las situaciones de capacidad o incapacidad laboral

The professional assessment is fundamental in order to evaluate the work capacity, in the medical inspections of the Spanish National Social Security Institute (NSSI). Our evaluating system of work ability/inability is essentially labour or professional, evaluating the functional or organic limitations related to the natural inability of the labour functions or the labour in general. This article handles with the main aspects of the professional or labour valuation using the concepts of Profession, Labour Ability, Labour Requests and the Ability, Able or Unable to. It deals as well with a review to the professional marking criteria and to the specific usual occupation. In our NSSI we do not only have urgently to define it but to stablish an update and a definition of the abilities to be valued and of the job, occupation, work and tasks concept. It is as well necessary to implement a contrasted and standardized evaluation methodology with an adequate normative reference, its applicable use and its validated scientific contrast. Material and Method: The texts published on the literature of this article and in the reference work mentioned in the literature have been reviewed. Conclusions: It seems strange that it is just recently when the lack of social security assessment tools changes into a social security disability rating system, where the concepts of "professional" or "labor valuation" play a main role. For a proper assessment of work capacity, it duly urges a valuation methodology and standardized measurement considering its regulated publication, its extensive use and its scientifically validated contrast. The assessment of skills or job skills required by the job need to establish a common system, an update and a definition of the skills to be assessed, as well as the concept of profession, occupation, work and tasks. It is therefore essential to specify what do we value and how do we do it in the "professional", "work ability", "occupational" or "work" social security rating system, updating meanwhile the concepts of inability and promoting a legal reform legislation to provide a better ability or inability work situation

Pathologizing poverty: new forms of diagnosis, disability, and structural stigma under welfare reform.

In 1996 the U.S. severely restricted public support for low income people, ending "welfare as we know it." This led to dramatic increases in medicalized forms of support for indigent people, who increasingly rely on disability benefits justified by psychiatric diagnoses of chronic mental illness. We present case studies drawn from ethnographic data involving daily participant-observation between 2005 and 2012 in public clinics and impoverished neighborhoods in New York City, to describe the subjective experience of structural stigma imposed by the increasing medicalization of public support for the poor through a diagnosis of permanent mental disability. In some cases, disability benefits enable recipients to fulfill important social roles (sustaining a vulnerable household and promoting stable parenting). The status of family members who receive a monthly disability check improves within their kin and neighborhood-based networks, counterbalancing the felt stigma of being identified by doctors as "crazy". When a diagnosis of mental pathology becomes a valuable survival strategy constituting the basis for fulfillment of household responsibilities, stigmatizing processes are structurally altered. Through the decades, the stigmatized labels applied to the poor have shifted: from being a symptom of racial weakness, to the culture of poverty, and now to permanent medical pathology. The neoliberal bureaucratic requirement that the poor must repeatedly prove their "disabled" status through therapy and psychotropic medication appears to be generating a national and policy-maker discourse condemning SSI malingerers, resurrecting the 16th century specter of the "unworthy poor".

[Sickness funds' activities for early detection, prevention and health promotion in depressive disorders]. / Krankenkassenprogramme zur Früherkennung, Prävention und Gesundheitsförderung bei Depressionen.

OBJECTIVE: We analyzed programs managed by the ten biggest social health insurance companies in Germany that aim at early detection, prevention, and promotion of health in depression. METHODS: We conducted interviews with the responsible managers and studied relevant web sites. RESULTS: The content of these programs ranges from internet-based offers to relaxation techniques. There is very little information publicly available on the results of these programs; the same holds true for the number of participants, efficiency, and cooperation with physicians. CONCLUSION: There is a strong need to investigate results and efficiency of the programs.